Effectiveness of Digital Mental Health Tools to Reduce Depressive and Anxiety Symptoms in Low- and Middle-Income Countries: Systematic Review and Meta-analysis (Preprint)

Abstract

BACKGROUND Depression and anxiety contribute to an estimated 74.6 million years lived with disability, and 80% of this burden occurs in low- and middle-income countries (LMICs), where there is a large gap in care. OBJECTIVE We aimed to systematically synthesize the available evidence and quantify the effectiveness of digital mental health interventions in reducing depression and anxiety in LMICs. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases from the inception date to February 2022. We included Randomized Controlled Trials (RCTs) conducted in LMICs that compared groups who received digital health interventions to controls (active control, treat as usual, or no intervention) on depression or anxiety symptoms. Two reviewers independently extracted summary data reported in the articles and performed study quality assessments. The outcomes were post-intervention measures of depression or anxiety symptoms (Hedges’ g). We calculated pooled effect size weighted by inverse variance. PROSPERO (CRD42021289709). RESULTS Among 11,196 retrieved records, we included 80 studies in the meta-analysis (12,070 participants: 6,052 in intervention and 6,018 in control) and 96 studies in the systematic review. Pooled effect sizes were -0.61 (-0.78 to -0.44; n = 67 comparisons) for depression and -0.73 (-0.93 to -0.53; n = 65 comparisons) for anxiety, indicating that digital health intervention groups had lower post-intervention depression and anxiety symptoms compared to controls. Although heterogeneity was considerable (I2=0.94 for depression and 0.95 for anxiety), we found significant sources of variability between studies, including intervention content, depression/anxiety symptom severity, control type, and age. Grading of Recommendations Assessments, Development, and Evaluation (GRADE) showed the evidence quality was overall high. CONCLUSIONS Digital mental health tools are moderately to highly effective in reducing depression and anxiety symptoms in LMICs. Thus, they could be effective options to close the gap in depression/anxiety care in LMICs, where the usual mental health care is minimal. CLINICALTRIAL N/A

Effectiveness of School-Based Oral Health Education for Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

“…As child and adolescent oral health could best be promoted in the school environment, health education components should get together to ensure health and education work in collaboration and improve health. 51…”